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General NPI Number Information
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NPI Number | 1629116546
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Entity Type | Individual
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Provider Name | CHARLIE JORDAN CHANEY APN
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Gender | Male
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 500 W 10TH ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1422
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Country | US
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Telephone | 302-984-3380
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Fax | 302-691-0475
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Provider Business Mailing Address
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Address Line | 500 W 10TH ST
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City | WILMINGTON
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State | DE
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Zip | 19801-1422
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Country | US
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Telephone | 302-984-3380
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Fax | 302-691-0475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | LE-0000160
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License Number State | DE
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